Arthritis Flashcards
Define osteoarthritis
Slowly progressive degeneration of articular cartilage
RF osteoarthritis (4)
Obesity
Occupation
Age
Female gender
What can cause secondary osteoarthritis
Inflammatory arthritis
Metabolic conditions
Trauma
Deformity
What deformity can cause secondary osteoarthritis
developmental dysplasia of the hip
What metabolic conditions can cause secondary osteoarthritis
haemochromatosis, Wilson’s disease
Presentation of osteoarthritis (4)
Pain worse at end of day
Asymmetrical joint stiffness, especially after inactivity
Joint crepitus
Restricted activity
Which joints are most commonly affected by OA (6)
Weight bearing joints (hip, knee) Heavy use (DIP, PIP, 1st CMC, wrist)
What is seen on the hands of OA patients and which one is which (2)
Heberdens node DIPJ
Bouchards node PIPJ
What is seen in the X ray of osteoarthritis (4)
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is seen in the joint aspirate of osteoarthritis (4)
Straw coloured fluid
Increased viscosity
RA definition
Chronic (>6 weeks), systemic inflammatory disease characterised by symmetrical deforming polyarthritis (>4 joints)
and extra-articular manifestations
How many joints are affected rheumatic arthritis
> 4
RF RA (2)
HLA DR4 mutation
Smoking
What is the gender ratio of RA
1:2
Male to female
What is the standard AI gender ratio
1 : 2 (autoimmune)
Male : female
History of RA
Pain worse at start of day
Joint stiffness for >1h in morning
Restricted activity
Which joints are affected in RA (6)
Small joints of hands (PIP, MCP, wrist – NOT DIP)
Other joints: hip, knee, shoulders
What later deformities are seen in RA (5)
Wrist: radial deviation
MCP: ulnar deviation of fingers, Z-deformity of thumb
PIP/DIP: Boutoinniere deformity, Swann neck deformity
Extra-articular manifestations of RA (7)
Rheumatoid nodules Lymphadenopathy Eyes: episcleritis Lungs/hearts: pleuritis (fibrosis) /pericarditis Amyloidosis Haematological: Anaemia of chronic disease Felty syndrome
What does synovial inflammation lead to in RA
Tenosynovitis
Bursitis
What haematological complications of RA can you get (2)
Anaemia of chronic disease
Felty syndrome
What is the Felty syndrome triad
Splenomegaly
Neutropenia
Anaemia of chronic disease
Systemic symptoms of RA (3)
Fever
Wt loss
Fatigue
What is seen in the X-ray of RA
Uniform joint space narrowing
Juxta-articular osteopenia
Joint erosions at joint margins
Joint deformity & destruction
What do you test for in the blood of RA (6)
Chronic inflammation: Anaemia of chronic disease ↑ ESR/CRP Low albumin Antibodies: Rheumatoid factor (IgM against IgG) Anti-CCP (most specific)
Which antibodies in RA
Rheumatoid factor (IgM against IgG) Anti-CCP (most specific)
What is primary amyloidosis associated with (3)
multiple myeloma, lymphoma, waldenstron’s macroglobulinaemia
What is secondary amyloidosis associated with (4)
with RA, IBD/UC, chronic infections (e.g TB)
What is the difference between primary and secondary amyloidosis
Primary amyloidosis (AL amyloidosis) Deposition of immunoglobin light chain
Secondary amyloidosis (AA amyloid) Deposition of serum amyloid A (acute phase protein)
Presentation of amyloidosis (6)
Nephrotic syndrome Hepatosplenomegaly Carpal tunnel syndrome + peripheral neuropathy Periorbital purpura Restrictive cardiomyopathy (1o) Macroglossia (1o)
Which presentation of amyloidosis is solely in primary amyloidosis (2)
Restrictive cardiomyopathy (1o) Macroglossia (1o)
Diagnostic test of amyloidosis
Apple-green birefringence under polarised light with Congo Red stain
What are the Seronegative spondyloarthropathies (4)
PEAR
Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis
Associations/presentation of the seronegative arthropathies (5)
HEADS
HLA B27 Enthesitis Asymmetrical oligoarthritis with Axial involvement and extra-articular involvement Dactylitis Seronegative
Gender distribution of seronegative spondyloarthropathies
Men more commonly
Age and sex of AS
Affects young men (<40yrs)
Extraarticular manifestations of AS (3)
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Where does AS affect
Affects spine (enthesitis) and sacroiliac joints (arthritis):
What happens in AS (4)
Gradual onset pain and morning stiffness
Eventually bone fusion, and loss of spinal movement
What changes to posture do you se in ankylosing spondylitis
Question-mark posture: loss of lordosis, kyphosis, neck hyperextension
Bloods to take in AS and what is seen in it
ACD, ESR/CRP, albumin
Best Ix for AS
MRI most sensitive
What is seen in X-ray of mild (1) and late (2) AS
Mild: sacroilitis
Late: syndesmophytes & bamboo spine
What is reactive arthritis
Sterile inflammation ~2 weeks after extra-articular infection
Which infections can cause reactive arthritis
GU infection (chlamydia, gonorrhoea) GI infection (shigella, campylobacter)
What triad is seen in reactive arthritis
Arthritis:
Asymmetrical oligoarthritis of lower limbs + spondylitis
Enthesitis:
Dactylitis, Achilles tendonitis, plantar fascitis
Reiter’s syndrome
“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis, urethritis, arthritis
What is Reiter’s syndrome
Reiter’s syndrome
“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis, urethritis, arthritis
What enthesitis manifestations is seen in reactive arthritis (3)
Dactylitis, Achilles tendonitis, plantar fascitis
Which organisms are usually involved in septic arthritis and which is more likely in which patient (2)
Staph. Aureus >30yrs
Neisseria gonorrhoea <30yrs
Main 2 RF of septic arthritis
Joint damage
Infection risk
What forms of joint damage can lead to septic arthritis (3)
Rheumatoid arthritis; prosthetic joint; gout
Which people are prone to infections that can lead to septic arthritis (3)
Immunosuppression; diabetes; IVDU
Presentation of septic arthritis (4)
Acute monoarthritis, usually affecting the knee: Exquisite pain Redness and swelling Restricted ROM Fever
Which joint does septic arthritis usually affect
Knee
Which Ix for septic arthritis and what results
Bloods: ↑ WCC, ↑ CRP Joint aspirate (before ABx): Turbid, yellow Low viscosity ↑ WCC (neutrophils >90%) MC&S
What is the crystal in gout
Monosodium urate crystals
What is the crystal in pseudogout
Calcium pyrophosphate crystals
What is the typical gout patient
Obese, middle-aged men
What is the typical pseudo-gout patient
Elderly women
What are the two presentations of gout
Acute monoarthritis
Classically 1st MTP (podagra)
Precipitated by: trauma, infection
Chronic tophaceous gout:
Polyarticular arthritis
Tophi deposits
Urate kidney stones
What is the two presentations of pseudo-gout
Acute monoarthritis
Classically large joints (knee)
Precipitated by: trauma, illness
Chronic CPPD
Polyarticular arthritis
Which joint(s) does gout typically affect
Classically 1st MTP (podagra)
Which joint(s) does pseudogout typically affect
Classically large joints (knee)
RF for gout (3)
Hyperuricaemia
↑ intake: alcohol
↑ production: tumour lysis syndrome
↓ excretion: diuretics
RF for pseudo-gout (7)
Idiopathic
HyperPTH, hypoPO4, hypoMg
Metabolic: haemochromatosis, Wilson’s, acromegaly
Metabolic causes of pseudo gout
haemochromatosis, Wilson’s, acromegaly
Precipitants of gout (2)
Precipitated by: trauma, infection
Precipitants of pseudo-gout (2)
Precipitated by: trauma, illness
Bloods of gout (3)
↑ WCC
↑ CRP
Uric acid after 4-6 weeks
Bloods of pseudogout (2)
↑ WCC
↑ CRP
How long for uric acid to be raised in gout
4-6 weeks
What is seen in the joint aspirate of gout
Turbid, yellow fluid
Low viscosity
↑ WCC (↑ neutrophilis)
What is seen in the joint aspirate of pseudo gout
Turbid, yellow fluid
Low viscosity
↑ WCC (↑ neutrophilis)
What is the result under polarised light of gout
Polarised light:
Needle shaped, negatively birefringent
What is the result under polarised light of pseudogout
Polarised light:
Rhomboid shaped, positively birefringent
What is seen in the X-ray of gout
Rate-bite erosions
What is seen in the X-ray of pseudogout
White lines of chondrocalcinosis
What is osteomyelitis
Infection of bone
What is most common organism in osteomyelitis
Staph aureus
What are the three ways of acquiring osteomyelitis
Haematogenous spread
Contiguous spread
Direct inoculating
Which patients are most at risk of haematogenous spread of osteomyelitis
IVDU
Immunosuppression
Diabetes
Sickle cell (Salmonella)
Presentation of osteomyelitis (3)
Inflammation (pain & swelling)
Reduced mobility
Fever
Which bones commonly get osteomyelitis in children
Long bones
What is TB osteomyelitis of the vertebrae known as
Potts disease
Which bloods do we take for suspected osteomyelitis (3)
↑ WCC
↑ ESR/CRP
Blood cultures
Which Ix is the most sensitive for osteomyelitis
X-ray